Dorien Brouwer

95 Health education in patients with recent stroke or transient ischemic attack PART 2 an intervention on the knowledge of stroke and TIA patients compared with standard care only. In a Cochrane review [20] , data were available for 536 of 770 participants from six trials. [21–26] Knowledge assessment of warning signs and risk factors varied between one- week and six-months. Overall, patients in the intervention groups had significantly more knowledge of stroke than those in the control groups. The magnitude of effect between passive and active information and the effect of individual tailored information was not different between the groups. Attitude and skills Patients with acute stroke often experience a significant delay in reaching the hospital. This delay has three components: appraisal delay, the time from noticing a symptom to deciding one is ill; illness delay, the time from onset of symptoms to seeking professional help; and utilization delay, time from seeking professional care to arrival at the hospital. [27] Especially the appraisal and illness delay are patient dependent. Data about appraisal delay in stroke patients are limited, but studies showed that a history of stroke contributes to heightened awareness and recognition of stroke symptoms. [18, 28] Data about the illness delay, the time from onset of symptoms to seeking help, are conflicting. Some studies showed that patients who knew they had a stroke did not promptly seek medical attention. Even when stroke symptoms were correctly recognized, most patients who delayed their call for help, interpreted their symptoms as ‘not serious’. [18, 29] Other observational studies suggest that if patients realize that they are having a stroke or have symptoms comparable with a previous experience, they seek medical treatment sooner. [17, 28] Studies reporting interventions aimed at changes in attitudes towards risk factors for stroke and TIA are not available. Studies have focused on risk factor changes and compliance with lifestyle advice, the next step in the process of HE aiming to reduce stroke death and disability (Fig. 1). Health behavior and risk factor modification A well-known problem at the behavioral level is the noncompliance with lifestyle advice. Vascular risk factors are negatively influenced by unhealthy lifestyles leading to obesity and an increased risk of hypertension, hypercholesterolemia and diabetes mellitus. Studies investigating the effect of HE on behavioral changes and risk factor modification in stroke and TIA patients are limited. We performed a small randomized controlled study with passive information provision to TIA and stroke patients provided by physicians vs. a combination of an individualized multimedia computer programme with physician support. We found no statistically significant differences between the two groups at three-months with regard to compliance with lifestyle recommendations [21] . Two trials showed there was no evidence of an effect of active information on the modification of health behaviors or risk reduction. [24, 30] The first trial investigated a